The University of Kentucky Markey Cancer Center, in conjunction with other key regional organizations proposes the establishment of the Central Highlands Appalachia Leadership Initiative on Cancer (CHALIC) in 15 Planning Districts and 107 Appalachian counties of Kentucky, Tennessee, and Virginia. The Project proposes to improve cancer prevention and control through the formation of community coalitions which will design, implement, and support comprehensive cancer control outreach activities, utilizing resources from a variety of public, private and governmental organizations. We propose to organize District Coalitions (DC) and Community Leadership Groups (CLG) to promote systems change in communities and facilitate the development, implementation, maintenance, and evaluation of long-range, comprehensive, multi-disciplinary, and community-wide projects. The CHALIC Project will establish an integrated cancer control outreach program that maximizes vertical and horizontal Links between federal, state, and community efforts in order to reduce cancer incidence and mortality and improve cancer survival rates in Central Appalachia; to prevent future cancer incidence and mortality rate increases; to reduce the negative health behaviors which increase cancer risks; to increase the level of knowledge of the population about the prevention and early detection of cancer; and to enhance the competence, and collective self-efficacy to address cancer and other health-related issues in these communities. Evaluation of process and outcomes will be carried out and cancer control research will be an integral part of the project.